Effect of large for gestational age on the success rate of vaginal trial delivery after cesarean section and maternal-infant complications
Objective To investigate the effect of full-term large for gestational age(LGA)on the success rate and maternal-infant complications of trial of labor after cesarean section(TOLAC).Methods Using a retrospective analysis method,1 577 full-term TOLAC pregnant women admitted to 4 hospitals from January 2015 to December 2022 were selected as the study subjects.According to the birth weight of newborns,they were divided into LGA group(125 cases)and non-LGA group(1 452 cases).The success rate of TOLAC was compared between the two groups.According to the success or failure of TOLAC,they were divided into TOLAC failure LGA group(36 cases),TOLAC failure non-LGA group(299 cases),vaginal delivery after cesarean section(VBAC)LGA group(89 cases)and VBAC non-LGA group(1 153 cases).The effects of LGA on maternal and infant complications under the same delivery method were compared.Results The success rate of TOLAC in the LGA group was lower than that in the non-LGA group(71.20%vs.79.41%)(P<0.05).There was no statistically significant difference in the comparison of maternal and infant complications between the two groups with TOLAC failure(P>0.05).The duration of the second stage of labor,the rate of uterine atony,the amount of bleeding at 24 hours after delivery,the incidence of postpartum hemorrhage and the rate of blood transfusion in the VBAC-LGA group(63.46±16.17 min、6.74%、424.65±118.34 mL、4.49%、2.25%)were higher than those in the non-LGA group(57.34±19.49 min、2.78%、385.27±132.81 mL、1.04%、0.43%)(P<0.05).There was no statistically significant difference between the two groups with VBAC in the duration of the third stages of labor,the incidence of shoulder dystocia,midwifery rate,III/IV perineal laceration rate,postpartum urinary retention rate,fever ratio,neonatal birth injury,1 min Apgar score,neonatal asphyxia rate and the proportion of transfer to neonatal department(P>0.05).Conclusion LGA reduces the success rate of TOLAC,and at VBAC,the second stage of labor is longer than that of non-LGA,and the incidence of postpartum uterine inertia and postpartum hemorrhage is increased.
large for gestational agetrial of labor after cesarean sectionmaternal and infant complicationspostpartum hemorrhageuterine inertia
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